Neuro Flashcards
Unilateral, severe periorbital HA with tearing and conjuctival erythema
Cluster HA
Prophylactic Tx migraine
AntiHTN
Antidepressants
Anticonvulsants
Diet changes
Most common pituitary tumor. Tx?
Prolactinoma DA agonist (bromocriptine)
55 yo pt presents with acute βbroken speechβ. What type of aphasia? What lobe and vascular distribution?
Brocaβs aphasia
Frontal Lobe, left MCA distribution
Most common cause SAH
Trauma
2nd: berry aneurysm
Crescent shaped hyperdensity on CT that does NOT cross midline
What vessels affected
Subdural hematoma
Bridging veins
Hx significant for initial altered mental status with an intervening lucid interval. Dx? Source? Tx
Epidural hematoma
Middle meningeal a.
Neurosurgical evacuation
CSF findings with SAH
Elevated ICP, RBC, xanthochromia
Albuminocytologic dissociation
GBS (inc protein in CSF without significant inc in cell count)
Cold water flushed into ptβs ear, fast phase of nystagmus toward opposite side, Normal or Pathological?
Normal
Most common primary sources of mets to brain
Lung
Breast
Skin (melanoma)
GI tract
May be seen in kids who are accused of inattention in class and confused with ADHD
Absence seizures
Most frequent presentation of intracranial neoplasm
HA
Primary neoplasm much less common than brain mets
Most common cause of seizures in children (2-10 yr)
Infection
Febrile seizures
Trauma
Idiopathic
Most common cause seizures young adults (18-35)
Trauma
Alcohol
Brain tumor
First line med for status epilepticus
IV BDZ
Confusion, confabulation, opthalmoplegia, ataxia
Wernickeβs due to def thiamine
% lesion for CAE
70% if Sx
Most common causes dementia
AD
multi-infarct
Combined UMN and LMN disorder
ALS
Rigidity and stiffness with unilateral resting tremor and masked facies
PD
Mainstay Tx PD
Leveodopa/carbidopa
Tx GBS
IVIG or plasmapheresis
Avoid steroids
Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior
HD
6 yo girl presents with port wine stain in V2 distribution with mental retardation, seizures, and ipsilateral leptomeningeal angioma
Sturge WEber
Tx: Sx
Possible focal cerebral resection of affected lobe
Multiple cafe au lait spots on skin
NF1
Hyperphagia, hypersexuality, hyperorality, hyperdocility
Kluver Bucy (amygdala)
May be administered to Sx pt to Dx MG
Edrophononium
ACA supplies
Medial and superior surfaces
Frontal lobes
MCA supplies
Lateral surfaces and temporal lobes
PCA supplies
Inferior surfaces and occipital lobes
Basilar artery supplies
Midbrain and brainstem-pons
AICA supplies
Brainstem (pons)
Part of cerebellum
PICA
Brainstem (medulla)
Parts of cerebellum
Dorsal columns medial lemniscus of spinal cord responsible for β¦
Anatomical structures involved with this pathwayβ¦
Pressure, vibration, 2 point discrimination, proprioception
Paciniβs
Meissnerβs
Mm spindles
Golgi tendon organs
Fasciculus gracilis
Lower body, extremities
Fasciculus cuneatus
Upper body, extremities
Lateral corticospinal tract responsible for, what parts of body
Voluntary Motor - contralateral
Arms more medial
Legs more lateral
Spinothalamic tract responsible for..
Anatomical structuresβ¦
pain and temperature
Sacral posterior
Cervical anterior
Free n endings, pain fibers
Tracts affected by ALS
Sx
Corticospinal trac - voluntary movement
anterior horn - motor
Sx: spastic and flaccid paralysis
Tracts affected by Poliomyelitis
Sx
anterior horn
Sx: flaccid paralysis
Tracts affect by tabes dorsalis
Part of what disease process
Sx
Dorsal columns
Tertiary syphilis
Impaired proprioception and pain
Tracts affected by Vit B12 def
Sx
Dorsal columns, corticospinal tract
Bilat loss vibration and discrimination; Bilateral spastic paresis affecting legs before arms
Tracts affected by spinal artery syndrome
Sx
Corticospinal, spinothalamic, central horn, lateral gray matter = DORSAL COLUMN SPARED
Sx: bilat loss pain and temp (one level below lesion), bilat spastic paresis (below lesion), bilat flaccid paralysis (level of lesion)
Syringomelia - tracts affected
Sx
anterior horn, anterior white commissure
Sx: Bilat loss of pain and temp (one level below lesion), bilat flaccid paralysis (level of lesion)
Brown Sequard Syndrome- tracts
Sx
All tracts on ONE SIDE of spinal cord
Sx: ALL ARE BELOW LESION- Ipsi loss of vibration and discrimination, ipsi spastic paralysis, contra loss of pain and temp
CN I
Type
Fcn
OLFACTORY
Sensory
Smell
CN II
Type
Fcn
OPTIC
Sensory
Sight
CN III
Type
Fcn
OCULOMOTOR
Motor
Medial, sup, inf rectus mm
Inf oblique mm, ciliary mm, sphincter of eye
CN IV
Type
Fcn
TROCHLEAR
Motor
Superior oblique of eye
CN V
Type
Fcn
TRIGEMINAL
Both
Sensation face, mm of mastication
CN VI
Type
Fcn
ADBUCENS
Motor
Lateral rectus of eye
CN VII
Type
Fcn
FACIAL
Both
Taste (ant 2/3 tongue), mm facial expression, sapedius mm, stylohyoid mm, digastric mm, lacrimal, submandibular, sublingual
CN VIII
Type
Fcn
VESTIBULOCOCHLEAR
Sensory
Hearing, balance
CN IX
Type
Fcn
GLOSSOPHARYNGEAL
Both
Taste (post 1/3 tongue), pharyngeal sensation, stylopharyngeus mm, parotid gland
CN X
Type
Fcn
VAGUS
Both
Sensation of trachea, esophagus, viscera; laryngeal, pharyngeal mm; visceral autonomics
CN XI
Type
Fcn
ACCESSORY
Motor
SCM and trapezius
CN XII
HYPOGLOSSAL
Motor
Tongue
Newborn most common cause meningitis
GBS
1 month - 2 yr most common cause meningitis
Strep pneumo
N meningitidis
2-18 yr most common cause meningitis
N meningitidis
18-60 yr most common cause meningitis
S pneumo
80+ most common cause meningitis
S pneumo
Reason to not do lumbar puncture
Signs of increased ICP -Papilledema -Focal neuro deficits -Pupil assymetry Risk of uncal herniation
Children with viral infection given aspirin
Reyeβs syndrome
Encephalitis
Brudzinski sign
Neck flexion in supine pt causes reflexive hip flexion
Kernig sign
Painful knee extension with hip flexion in supinre pt
Meningitis + N. meningitidis causes what Sx
Petechiae
Tx bacterial meningitis
3rd gen cephalosporin until cultures return
Close contacts: Rifampin and cipro if Neisseria
Tx fungal meningitis
Amphotericin B
Tx TB meningitis
RIPE
Rifampin, isoniazid, pyrazinamde, ethambutol
Labs meningitis: Inc WBC w/ PMN, INc P, Dec Glc, Dec Prot
Bacterial
Labs meningitis: Inc WBC w/ lymph, INc P, dec glc, inc prot
Fungal or TB
Labs meningitis: inc WBC w/ lymph, INc P, glc and prot normal
Viral
Encephalitis infection - skin lesions
HSV
Encephalitis infection - parotid swelling
Mumps
Encephalitis infection- macupapular rash
WNV
Ring enhancing lesion
Brain abscess
Negri bodies
Rabies
Round eosinophilic inclusions in neurons
Branches affected in trigeminal neuralgia
Maxillary(V2) and mandibular (V3)
Tx trigeminal neuralgia
Carbamazepine
Baclogen, phenytoin, gabapentin, valproate, clonazepam, other antivonculsants
Unilateral throbbing HA w/ N/V
Migraine
Tx migraines
NSAID, ergots, sumatriptans, metoclopramide
Prophy: TCA, Beta blocker, CCB, ergots, anticonvulsants
HA in young man, unilateral, periorbital, lacrimation, Horner
Cluster
Tx cluster
100% O2, ergots, sumatriptan
Prophy like migraines
Horner syndrome
Ptosis
Miosis
Anhidrosis
Bilateral HA with tightness in occipital region or neck
Tension
Tx tension
NSAID, ergots, sumatriptan, relaxation exercises
TIA w/ carotid bruits
Suggest atherosclerosis origin
TIA w/ harsh systolic murmur
Suggest AS cause
Why not Tx HTN immediately after stroke
When to Tx
Dec cerebral perfusion
YES: BP >220/120 or CAD
Associated with berry aneurysm
polycystic kidney disease
Marfan
Traumatic lumbar puncture vs SAH
Traumatic- decline RBC in CSF
Lucid interval
Epidural
Slowly progressive HA wks to days -brain hematoma
Subdural
Convex, lens shaped hyperdensity
Epidural
Concave, crescent hyperdensity
Subdural
Hematoma crosses midline
Epidural
Emergent surgery drainage essential
Epidural
Rupture middle meningeal a/
Epidural
Rupture bridging vv
Subdural
Aphasia: nonfluent with good comprehension, writing aphasia, aware of inabilities
Broca (Expressive)
Located Broca
Inferior frontal gyrus, dorsolateral frontal cortex, anterior parietal
Poor comprehension, word salad, neologisms, not aware of disorder
Wernicke
Posterior superior temporal gyrus, inf parietal lobe
Wernicke
Fluent speech, frequent attempt to corrext word, word substitations
Conduction
Supramarginal gyrus and angular gyrus
Conduction
Nonfluent speech and poor comprehenesion
Global
Large infarct left cerebral hemisphere
Globral
3 W normal P hydrocephalus
Wacky- cognitive impaired
Wet- incontinence
Wobbly- gait changes
Epilepsy vs seizures
Epilepsy: recurrent seizures
Generalized vs partial seizures
Generalized: entire cortex
Partial: focal neuro deficits
Focal sensory or motor WITHOUT loss of consciousness
Simple partial
Sensory- paresthesias, hallucinations
Motor- repetitive or purposeless movement
Hallucinations, automatisms, deja vu, impaired consciousness, postictal
Complex Partial
Sustained contraction of mm (name), repetitive contract and relax (name) brief contraction then repetitive contraction (name), brief repetitive contractions (name), loss of tone (name)
LOSS OF CONSCIOUSNESS, postictal, unilat weakness lasting hrs (name)β
Tonic Clonic Tonic clonic myoclonic atonic Todd paraylsis
Generalized
Brief episodes (5-10 s) of impaired consciousness with normal mm tone, possible eye blinking, no postictal, children
Appear to be daydreaming, are amnestic of evet, stare off into space
Absence
Most commonly in temporal lobe (seizure)
complex partial
EMG shows 3 cycle/s spike and wave pattern
Absence/petit mal
Repetitive or unremitting seizures for > 20 minutes without any period of consciousness
Tx
Status epilepticus
Tx: IV BDZ, if refractory phenobarb or pentobarb
Common signs of PD
SMART Shuffling gait Masklike facies Akinesia Rigidity (cogwheeling) Tremor (resting)
Spasticity, increased DTR, + Babinski
UMN damage
Flaccid paralysis, atrophy, fasciculations decreased DTR, - Babinski
LMN damage
Neurodegenerative disorder that affects substantia nigra
PD
Neurodegenerative disorder that affects anterior horn and corticospinal
ALS
Neurodegenerative disease affecting caudate and putamen
HD
Lewy bodies
PD
Cortical atrophy
AD
White matter atrophy w/ oligoclonal bands on LP
MS
AB bind AchR Testing Tx Assoc Sx
MG Edrophonium improves Sx Anticholinesterase: neostigmine, pyridostigmine Thymoma, thyroiditis, thyrotoxicosis Sx: proximal mm weakness
Paraneoplastic, Ab to presynaptic Ca channels
Lambert Eaton
Most commonly assoc w/ lung ca
Tx benign essential tremor
Beta blocker Primidone Clonazepamn Thalamotomy Deep brain stimulation
Chorea - assoc diseases
HD Hyperthyroidism Stroke SLE Levodopa use Rheumatic fever (Sydenham)
Describe athetosis
Associated diseases
Writhing snakeline movements Cerebral palsy Encephalopathy HD Wilson disease
Described dystonia
Assocaited diseases
Sustained proximal limb and trunk contractions Wilson PD HD Encephalitis Tardive dyskinesia
Describe hemiballismus
ASsociated diseases
Flinging of extremities
Stroke of subthalamic nucleus
Associated disease w/ tics
Tourette
OCD
ADHD
Most common primary brain tumor adults
Glioblastoma
Most common primary brain tumor kids
Astrocytoma- benign
Medulloblastoma - malignant
Tentorium as landmark, where are tumors adults vs kids
Adults: above
Kids: below
chr 22- nf1 or 2
2
chr 17 - - nf1 or 2
1
bilat acoustic neuroma - nf1 or 2
2
Dx criteria NF1
COFFINS
Cafe au lait Optic glioma Freckling FH Iris hamartomas Neurofibromas Skeletal lesions
BDZ affect on sleep cycle
Lengthen N2, shorten N3
Coma causes: pupils large, nonreactive - where lesion
Below midbrain (CN III involved) Possible uncal herniation
Coma causes: pupils small and reactive- where lesion
Thalamic involvement, transtentorial herniation
Coma causes: pinpoint pupils
Opiod
Coma causes: pupils immobile
Metabolic
Normal response to ice water in ear
Conjugate deviation toward ice water
Ice water in ear - no ABD or ADD
CN VI, CN III
Ice water in ear - conjugate nystagmus
Psychogenic
Spastic paralysis - where lesion
High spinal cord
Decorticate posturing - elbow flex, legs extended - where lesion
Cortical or thalamic compression
Decerebrate posturing - elbow extend, legs flex - where lesion
Pontine, medullary
Describe persistent vegatative state
Recovery unlikely after how long
Normal sleep cycles, inability to perceive/respond to environment, preserved ANS >1 month
> 3 month
Type of seizure with febrile seizure
Tonic clonic
Communicating vs noncommunicating hydrocephalus
Noncomm: obstruction 4th ventricle
Comm: dysfcn subarachnoid cistern or arachnoid villi
Cherry red spots on retina, Ashkenazi Jew
Enzyme def
Genetics
Tay Sachs
Hexosaminidase A (ganglioside)
AR
Defect in closure of vertebral arches, usu at LS jcn
Spina bifida occulta
Defect in closure of vertebral arches with meninges and spinal cord herniation
Myelomeningocele
Defect in closure of vertebral arches with herniation of meninges
Meningocele
Failure of NT closure, absence forebrain, meninges, portions of skull
Ancephaly
Labs during pregnancy that indicate neural tube problems
Increased alpha fetopreotin and acetylcholinesterase
2 types cerebral palsy
Spastic
Dyskinetic: choreathetoid, dystonic ataxic
Argyll Robertson pupil
What is it
Diseases
Accommodation to near object, nonreactive to light
Syphilis, SLE, DM
Marcus Gunn pupil
What is it
Diseases
Light in affected pupil causes minimal bilat constriction
Light in normal pupil- normal bilat constriction
Afferent n defect
Horner syndrome
What is it
Diseases
Ptosis, miosis, anhidrosis
Sympathetic trunk lesion (Pancoast tumor)
MLF syndrome
What is it
Diseases
With lateral gaze, absent contralat eye adduction
Intracranial lesion, MS
Adie pupil
What is it
Diseases
Minimally reactive dilated pupil
Abnormal innervation of iris
Focal point anterior to retina, refracting power of eye too great
Myopia
Far vision blurry
Image focal point posterior to retina
Refracting power of eye insufficient
Hyperopia
Near vision blurry
Asymmetric cornea surface causing inconsistent refraction of light
Astigmatism
Deviation of eye unable to be overcome by normal motor control
Strabismus
Double vision and progressive blindness
Development defect in neural pathways of eye leading to poor visual acuity and spatial differentiation in affected eye
Amblyopia
Uveitis - 3 areas affected
Iris
Choroids
CIliary bodies
Anterior vs Posterior uveitis
Ant: painful, slit lamp shows inflammation and keratin deposits on corniea
Post: slit lamp shows eye inflammation and retinal lesions
Most common viral cause conjunctivitis
Adenovirus
Bacterial conjunctivitis in young people
Chlamydia
GC
Perinatal from mom to baby
GC
C. trachomatis
When to suspect glaucoma
Frequent changes of lens prescriptions
Open vs closed angle glaucoma
Open: gradual
Closed: acute
Glaucoma vs macular degen vision loss
Glaucoma: peripheral to central, closed unilat
Macular: central to peripheral, bilat
Retinal a vs v occlusion exam
Artery: cherry red spot
Vein: cotton wool spots, edema, retinal hemorrhages
Retinal a vs v occlusion exam
Artery: cherry red spot
Vein: cotton wool spots, edema, retinal hemorrhages
Causes otitis media
Strep pneumo H. flu Moraxella S pyogenes Viruses
Tx otitis media
Unresolved - 10 d amoxicillin; resistant use amoxicilin- clauvulanic acid or stronger cephalosporin
Complications otitis media
Mastoiditis Meningitis Hearing Loss Sigmoid sinus thrombosis Middle ear drainage
Causes otitis externa/swimmers ear
Staph aureus
Pseudomonas
S epidermidis
Tx otitis externa
Topical polymyxin, neomycin, hydrocortisone
Pseudomonas: oral ceph or cipro
Dix Hallpike maneuver
Moving from sit to supine while turning head to side induce nystagmus in benign positional vertigo
Cause benign positional vertigo
Tx
Otolith in inner ear - problem w/ semicircular canal
Tx: Epley, meclizine CI
Cause meniere/endolymphatic hydrops
Vertigo caused by distension of endolymph compartment of inner ear
LOW FREQUENCY HEARING LOSS
Tx meniere
Antichol, antiemetics, antihistamine decrease exacerbation; thiazide reduce occurrences; surgery
Benign tumor of Schwamm cells of CN VIII can lead to hearing loss 2/2 nerve compression
Acoustic neuroma/ schwanomma
Preserved bone conduction, poor air conduction
Conductive hearing loss confirmed via Rinne test
Both impaired bone and air conduction
Asymmetric Weber, normal Rinne shows sensorineural hearing loss
Biceps DTR
C5
Triceps DTR
C7
Patella DTR
L4
Achilles DTR
S1
Babinski sign indicates
UMN lesion, ok first year of life
Stroke - aphasia of dominant hemisphere, neglect of nondominant hemisphere, contralateral paresis and sensory loss in face and arm, gaze toward lesion, homonymous hemianopsia
What vessel?
MCA
Stroke- Contra paresis and sensory loss in leg, cognitive or personality changes
What vessel?
ACA
Homonymous hemianopsia, memory deficits, dyslexia/alexia
What vessel?
PCA
Locked in syndrome, coma, CN palsies (diplopia), apnea, visual Sx, drop attacks, dysphagia, dysarthria, vertigo, βcrossed weakness and sensory lossβ affecting the ipsi face and contra body
What vessel?
Basilar artery
Pure motor or sensor stroke, dysarthria - clumsy hand syndrome, ataxic hemiparesis
Basal ganglia lacunar
MCA stroke Sx
CHANGes Contralateral paresis and sensory loss in face and arm Homonymous hemianopsia Aphasa- dominant Neglect- nondominant Gaze toward lesion
CI tPA therapy after stroke
SAMPLE STAGES
Stroke or head trauma in last 3 months Anticoag with INR>1.7 or prolonged PTT MI recent Prior intracranial hemorrhage Low platelet 185 or >100 Surgery past 14 d TIA Age 400 or low <50 glc Seizures present at onset of stroke
Conditions associated with berry aneurysm that make SAH more likely
MAKE and SAH more likely
Marfan Aortic coarctation Ehlers Danlos Sickle cell Atherosclerosis History - Fh
2/2 mass lesions of frontal lobes, no specific s/s, see on CT - type of herniation
Cingulate
Large supratentorial mass lesions push midbrain inferiorly; presents with rapid change in mental status, bilat small and reactive pupils, Cheyne-Stokes respiration, flexor or extensor posturing
Downward transtentorial (central) herniation
2/2 mass lesions of middle fossa. CN III entrapped leading to fixed and dilatered ipsi pupi followed by eye that is down and out. Ipsilesional hemiparesis (false localizing) results from compression of cerebral peduncle against tentorial edge
Uncal herniation
2/2 posterior fossa mass lesions. Tonsillar herniationβ>medullary compressionβ>respiratory arrest. Usually rapidly fatal
Cerebellar tonsillar herniation into foramen magnum
HA associated with vascular and 5HT changes
Migraine
Classic vs common migraines
Classic: unilat w/ preceeding visual aura with scotomas (bright or flashing lights) or visual field cuts
Common: May be bilat and periorbital without preceeding auras
Most common organism of cavernous sinus thrombosis
S aureus
Fungi- Mucor or Aspergillus
Dx cavernous sinus thrombosis
MRI with gadolinium, MR venograph
Tx cavernous sinus thrombosis
Penicillinase resistant Rx (nafcillin and oxcillin) + 3rd/4th cephalosporin
Need IV abx 3-4 wks
elevated postictal
Prolactin
Generalized epilepsy in infant, interictal EEG with hypsarrhythmia
Tx
Infantile spasms/West syndrome
Tx: ACTH hormone, prednisone, clonazepam, valproic acid
Childhood onset seizure, refractory to Tx, daily multiple seizures, ages 2-6, assoc mental retardation, behavior disorders, abnormal interictal EEG with slow spike and wave complexes
Lennox-Gastaut syndrome
Acute onset severe vertigo, head motion intolerance, gait unsteadiness, N/V, nystagmus
If has auditiory or aural Sx?
If not?
Acute peripheral vestibulopathy
Labyrinthitis Vestibular neuritis (can be Dx after viral infection)
Recurrent vertigo without auditory Sx that affect migraine suffers
Vestibular migraine
Like Meniereβs without auditory or visual Sx
Repetitive nerve stimulation
MG vs Lambert Eaton
MG: decremental response
Lambert: incremental response
Triad of MG
Scanning speech
Intranuclear opthalmoplegia
Nystagmus
Cause GBS
CAMPYLOBACTER JEJUNI, virus, influenza
Presentation GBS
Acute, rapidly progressive demyelinating AI of peripheral nn == WEAKNESS, ascending paralysis
5 A GBS
Acute inflammatory demyelinating polyradiculopathy Ascending paralysis Autonomic neuropathy Arrhythmias Albuminocytologic dissociation
Type of MS: full recovery or deficits may remain after each episode
Relapsing-remitting
Type of MS: minor remission and plateaus may take place during progression
Primary progressive
Type of MS: full recovery or progressive deficits after each episode
Progressive relapsing
Type of MS: relapses, minor remissions, plateaus may take place during progression
Secondary progressive
Best prognosis MS
relapsing remitting
Causes dementia
DEMENTIAS NeuroDegenerative diseases Endocrine Metabolic Exogenous Neoplasm Trauma Infection Affective disorders Stroke/Structural
Pseudodementia
Difference with AD is in pseudo pt concerned about memory loss
Triad normal pressure hydrocephalus
Dementia-wacky
Gait aprazia-wobbly
Urinary incontinence- wet
Rapid cognitive decline over wks to months
CJD
Gait PD vs normal P hydrocephalus
NPH: arms still swing
Primary CNS tumor arises in brain parenchyma. Presents with seizures and focal deficits
Astrocytoma
Primary CNS tumor with high mitotic activity and endothelial proliferation/necrosis in tumor = ring enhancing lesion with central necrosis on MRI
Glioblastoma multiforme
Poor prognosis
Originates from dura mater or arachnoid, imaging reveal dural tail
Meningioma
Derived from Schwann cells, presents ipsi tinnitis, hearing loss, vertigo
Acoustic neurona/ Schwannoma
Primary CNS tumor kids: primitive neuroectodermal from 4th ventricle causes inc ICP, very malignant
Medulloblastoma
ARise from epndyma of centricle or spinal cord, low grade, may cause obstructive hydrocephalus
Ependymoma
Most common suprasellar tumor in kids, calcification common, benign, may cause hypopituitarism
Craniopharyngioma
Convulsive seizures, ash leaf lesions, mental retardation, shagreen patch, sebaceous adenoma
Tuberous sclerosis
Vit def Wernicke and Korsakoff
Vit B1/thiamine
Triad Wernickeβs
Encephalopathy
Opthalmoplegia
Ataxia
Korsakoff
Wernicke + anterograde and retrograde amnesia, horizontal nystagmus, confabulations
Peripheral neuropathy Vit Def
B12/cyanocobalamin
Posterior and lat columns of spnal cord
Vit def: irritability, personality changes without neuro Sx
Folate
Positive India Ink prep
Cryptococcus
Area: decreased or no reflexes or fasciculations
LMN
Area: hyperreflexia
UMN
Area: apathy, inattention, unhibited or labile affecte
Frontal lobes
Area: Broca/motor aphasia
Dominant frontal lobe
Area: Wernicke/sensory aphasia
Dominant temporal lobe
Area: memory impairment, aggression, hypersexuality
Temporal lobes
Area: inability to read, write, name, do math
Dominant parietal lobe
Area: ignoring one side of body, difficulty dressing
Nondominant parietal lobe
ARea: visual hallucinations, illusions
Occipital
Area: CN III and IV
Midbrain
Area: CN V< VI< VII< VIII
Pons
Area: CN IX, X, XI, XII
Medulla
Area: ataxia, dysarthria, nystagmus, intention tremor, dysmetria, scanning speech
Cerebellum
Area: resting tremor, chorea
Basal ganglia
Area: hemiballismus
Subthalamic nucleus
Anosmia plus hypogonadism 2/2 def gonadotropin releasing hormone
Kallman syndrome
Intracranial HTN, papilledema, daily HA worse in morning, may be N/V, obese
Pseudotumor cerebri
Tx meningitis <1 month
Ampicillin: Listeria
Cefotoxamine:
Vancomycin: MRSA
Tx meningitis 1month to 50 yrs
Vancomycin
Ceftriaxone
Prophy for meningococcal meningitis
Rifampin or cipro
AR degeneration of anterior horn cells (LMN), hypotonic at birth, slowly progressive course
Werdnig Hoffman disease
Ragged red fibers on mm biopsy
Mitochondrial myopathies- Leverl hereditary optic atrophy
Cause resting tremor
basal ganglia disease
Cause intention tremor
Cerebellar disease
Cause hemiballismus
Subthalamic nuclei
Orthostatic hypotension
Drop BP >20 mmHg or reflex tachy 20 bpm
Cushing triad indicating inc ICP
Increasing BP
Bradycardia
Respiratory irregularity
Conjunctivitis that occurs in first 24 hrs of life
Most likely chemical 2/2 silver nitrate/erythromycin given prophy for GC conjunctivitis prevention
Conjunctivitis in infant at age 2-5 d, purulent discharge
Mom has Sx
GC; Tx topical erythyromycin plus IV or IM 3rd gen cephalosporin
Conjunctivitis of infact at age 5-14 d
Mom no Sx
Chlamydia
Tx: systemic abx - oral erythromycin to prevent chlam pneumo
Dot blot hemorrhages, microaneurysms, neovascularization - retinal changes in what disease?
DM
Arteriolar narrowing, copper or silver wiring, cotton wool spots, papilledema- retinal changes in what disease
HN
Sudden unilateral painless vision loss
Central retina a/v occlusion
Retinal detachment
Stroke or TIA - amaurosis fugax
Vitreous hemorrhage
Sudden unilateral painful vision loss
Closed angle glaucoma
Migraine
Optic neuritis or papillitis
Trauma
Sudden bilateral vision loss
Conversion reaction or hysteriA
Exposure to UV
Toxins- methanol
Gradual onset vision loss, uni or bi
Cataracts Diabetes Direct insult to brain Eye infection Open angle glaucoma Macular degen Optic neuritis Papilledema Presbyopia Uveitis
Cataracts in neonate
TORCH Toxoplasmosis Other Rubella CMV HSV
Presbyopia
inability to accomodate to near vision
Orbital cellulitis vs preorbital cellulitis
Both: fever, swollen eyelids, history trauma,
Orbital: opthalmoplegia, proptosis, severe eye pain, dec visual acuity = MEDICAL EMERGENCY
Most common bugs orbital/periorbital cellulitis
Strep pneumo, Hib, staph or strep
Complication orbital cellulitis
Meningitis
Vein thromboses
Blindness
Hordeolum
Painful red lump along eyelid margin 2/2 acute glandular obstruction
Chalazion
Painless lump on eyelid margin from chronic granulomatous inflammation
Conjuctivitis and vesicular eyelid eruption that progresses to dendritic keratitis seen with fluorescein
Herpes simplex keratitis
Tx: topical antiviral s(idoxuridine or trifluridine)
NO STEROIDS
When to refer child with lazy eye or strabismus
> 3 months
Lesion CN III/oculomotor causes
Eye down and out, latearl movement only possible
Resolves on own
If pupil blown, emergency!!
Lesion CN IV/trochlear causes
When gaze is medial, pt cannot look down = vertical diplopia
Lesion CN VI/abducens causes
Cannot look laterally = horizontal diplopia
Most common
Lesion CN V and VII causes
corneal drying due to loss of corneal blink reflex